Motivational Interviewing in Child Care Social Work

Motivational Interviewing in Child and Family Social Work - Helping People to Change.

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This article is devoted to a discrete communication style which was developed by workers within the substance misuse field but which is now being with remarkable results when working with individuals and families across all service areas. This is quite a long article with lots of dialogue and it doesn't look very nice on the screen. Perhaps you might like to print it out.

Unlike other communication styles it is completely non-confrontational and allows individuals to address problems which in other circumstances they would avoid or deny having.

Motivational Interviewing is an approach designed to help individuals and families build commitment and reach a decision to change. This approach helps people to recognise and do something about their present or potential problems and is particularly useful with people who are reluctant to change and ambivalent about changing. This non-authoritarian approach to helping people free up their own motivations and resources is a powerful technique for helping individuals and families to get ‘unstuck’

In Motivational Interviewing, responsibility for change is left with the individual. The strategies of Motivational Interviewing are persuasive and supportive. The overall goal is to increase the person’s intrinsic motivation so it is the person who presents the arguments for change.

As a helper, you want to help the person:

· Recognize the problem

· Understand the problem concerns them

· Get to the point of recognising the need to change

· Feel optimistic that they can change

The worker uses four common strategies to accomplish the above:

· Asking open-ended questions rather than closed questions

· Affirming their strengths and accomplishments

· Reflective listening in a very strategic manner, so they know you’ve listened and understood, as well as to help them understand better themselves

· Summarising what is being said in a way to help the person understand themselves better

Resistance

A key concept in this approach is that of resistance. Something that we come across a great deal in all areas of social work. I am sure that you are familiar with all of these signs of resistance:

Argument: the person contests the accuracy, expertise, or integrity of the helper.

Challenging: the person directly challenges the accuracy of what the helper has said.

Discounting: the person questions the helper’s personal authority and expertise.

Hostility: the person expresses direct hostility toward the helper.

Interruption: the person breaks in and interrupts the helper in a defensive manner.

Talking Over: the person speaks while the helper is still talking, without waiting for an appropriate pause or silence.

Cutting Off: the person breaks in with words obviously intended to cut the helper off. Denial: the person expresses an unwillingness to recognise problems, cooperate, accept responsibility, or take advice. (Not a character flaw).

Blaming: the person blames other people for problems.

Disagreeing: the person disagrees with a suggestion that the helper has made, offering no constructive alternative. (This includes the familiar “Yes, but…”)

Excusing: the person makes excuses for his/her behaviour.

Not Me: the person claims that he or she is not in danger.

Minimising: the person suggests that the helper is exaggerating risks or dangers.

Pessimism: the person makes general statements about self or others that are pessimistic, defeatist, or negative in tone.

Reluctance: the person expresses reservations and reluctance about the information or advice given.

Unwilling to Change: the person expresses a lack of desire or an unwillingness to change, or an intention not to change.

Ignoring: the person shows evidence of not following/ ignoring the helper.

Inattention: the person’s response indicates that he or she has not been following or attending to the helper.

Non-answer: in answering a helper’s query, the person gives a response that is to an answer to the question.

Non-response: the person gives no audible or non-verbal reply to a helper’s query.

Sidetracking: the person changes the direction of the conversation that the helper has been pursuing.

Not doing what they said they would do.

What Can Workers Do With Resistance?

There are two key practitioner responses to resistance. If you are to create or maintain progress you have to avoid argumentation at all costs. Confrontation is counterproductive, people will begin to defend their position even if previously they were ambiguous about it. Confrontation of resistance makes resistance stronger. What you pay attention to gets bigger.

When you come across resistance you need to change strategies. Roll with it. Momentum can be used to good advantage and perceptions can be shifted. New perspectives can be invited without being imposed. The individual is a valuable resource in finding solutions to problems.

Strategies for Handling Resistance

Listening: respond to resistance with non-resistance.

Person: “I’m not the one with the problem. If I drink too much, it’s just because my kids are always nagging me.”

Helper: “It seems to you that the real reason you drink so much has to do with problems with how the kids behave.”

Shift focus: shift the person’s attention away from what seems to be a stumbling block.

Person: “I know that what you want is for me to be the perfect mum and never hit my kids, but I’m not going to do that.” (Denying-unwillingness)

Helper: “I don’t want us to get stuck on that one thing. I’m more interested in how you see things about...” (then change the topic)

Agree with them with a twist: offer initial agreement but with a slight twist.

Person: “Why are you and my parents so stuck on my drinking? What about all their problems? You’d drink too, if you family was nagging you all the time and locking the doors to keep you out.” (Denying-blaming, excusing)

Helper: “You’ve got a good point there, and that’s important. There is a bigger picture here and maybe I haven’t been paying enough attention to that. It’s not as simple as one person’s drinking; I agree with you that we shouldn’t be trying to place blame here. Problems like these do involve the whole family. I think you’re absolutely right.”

It’s up to them: when people think that their freedom of choice is being threatened, they tend to react by asserting their liberty. It is advised to not use this response to resistance when the harm is so high that the helper cannot risk the parent making a choice to continue that harm.

Person: “I’ll show you; nobody tells me what to do!”

Helper: Assure the person that in the end, it is they who determine what happens, even if the harmful behaviour continues resulting in the removal of the children. Let them know that you want to help keep the family together, and say things like:

“What you do with this information is completely up to you.”

“Nobody can change your behaviour for you. It’s really your decision.”

“I can’t decide for you, and I couldn’t change you, even if I wanted to. You’re a free person, it’s up to you.”

“If you decided that you don’t want to change, then you won’t. If you want to change, you can. It’s your choice, I can only help you make the best choice, or take other action if the kids remain at risk.”

A new way to look at it: reframe information that the person is offering. The approach acknowledges the validity of the person’s raw observations, but offers a new meaning or interpretation for them.

Person: “My kids quit their fighting when I threaten them, so it works.”

Helper: “That’s an interesting situation actually. It seems that some kids do quit the immediate behaviour, but don’t understand how to keep doing that. Instead, they just fight again, until you threaten them again, and so on. Have you ever noticed that?”

Eliciting Self-Motivational Statements

In this approach workers elicit self-motivational statements from clients. The goal is to have the client take the ‘positive’ side of the argument. This is done by asking questions, initially to get the person to recognise the problem, the worker might be asking things like:

Problem recognition

“What things make you think this is a problem?”

“What difficulties have you had regarding drug use?”

“In what ways do you think you or other people have been harmed by your behaviour?”

“In what ways has this been a problem for you? “

“How has your use of spanking stopped the children from doing what you don’t want them to do?”

“What do you see as the reasons we need to keep talking to each other?”

“What might happen if you and I don’t work together on this situation?”

Concerns

“What is there about your drinking that you or other people might see as reasons for concern?”

“What worries you about your child’s lack of development?”

“What can you imagine happening to her if this doesn’t change?”

“How do you feel about the crying when you hit the children?”

“In what ways does this concern you?”

“What do you think will happen if you don’t make a change?”

Intention to change

“The fact that we’re here together indicates that at least a part of you thinks it’s time to do something. Tell me about that.”

“What reasons do you see for changing how you discipline your children?”

“What makes you think that you may need to make a change in your drug use?”

“If you were 100% successful and things worked out exactly as you would like, what would be different?”

“What things make you think you should keep on drinking the way you have been? And what about the other side? What makes you think it’s time for change?”

“As we’ve talked about, leaving your children alone is not okay. What are you thinking about changing regarding that?”

“What would be the advantages of making a change?”

“I can see that you’re feeling stuck at the moment. What’s going to have to change so your kids can stay here with you?”

Optimism

“What makes you think that if you did decide to make a change you could do it?”

“How will your relationship with your children improve when you do this?”

“What’s the best outcome for your family to result when you stop hitting each other?”

“What encourages you to think that you can change if you want to?”

“What do you think would work for you, if you decided to change?”

The goal is to have the person take the positive side of the argument, identify reasons for concern, decide to make changes and come up with positives about this change and their ability to do it. The individual presents the arguments for change, the worker creates the safe and unchallenging space that makes them feel secure enough to do this. Motivational Interviewing is the opposite of a confrontation / denial approach in which the helper promotes the problem-change position. Our goal is to have the person give voice to exactly the opposite kinds of statements.

This article is drawn from ‘Preventing Breakdown’ by Mark Hamer. Published by Russell House 2005

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